Substance misuse and comorbid psychiatric disorders

Abstract

There is strong evidence for the occurrence of substance misuse and comorbid psychiatric disorders in community and clinical settings. The pattern of this comorbidity varies between comorbid mood, anxiety and personality disorders in patients accessing addiction services and comorbid alcohol, cannabis and cocaine misuse in patients accessing general psychiatric services. Comorbidity is associated with increased risk for violence, suicide and worse clinical and social outcome. Whilst its diagnosis remains challenging, diagnostic guidelines including DSM-IV derived ones offer a major advance in offering criteria for distinguishing substance induced (organic) and independent (primary) psychiatric comorbidity. Treatment is guided by evidence-based and experience-based approaches which should be optimally provided in integrated models of services where substance misuse and comorbid psychiatric disorders are managed by professionals who are skilled in both domains whether working in community/hospital settings or addiction/general psychiatric services.